2 research outputs found
Experimental studies on the role of the gastrointestinal microflora in postsurgical adhesion formation
Introduction:
Adhesions occurring after any kind of surgery is a common phenomenon and
cause a great deal of morbidity and mortality, incurring a considerable
burden on health care systems. Adhesions are especially prominent after
lower abdominal and gynecological procedures (60-90 % of patients after
one operation) causing infertility, pain syndromes and bowel obstruction
as well as complicating subsequent surgery. Despite many attempts there
are still no satisfactory ways or means for prophylaxis or treatment.
Part of the difficulties is due to lacking in understanding of the basic
pathogenesis behind adhesion formation. Infection is regarded as
promoting adhesions. Intra-abdominal antibiotics have been used as an
adjunct to fertility surgery. Adhesions are particularly common in the
abdominal cavity where the close proximity to the gastrointestinal flora
may be of importance.
Rationale and Aims:
In order to study the role of the microbial flora in adhesion formation a
number of studies were undertaken.
I. To study the role of the gastrointestinal flora in germfree and
conventional rats.
II. To study the role of the flora in the germfree and exgermfree states
and to develop an objective
scoring scale.
III. To study healing of colonic anastomoses and adhesion formation in
vitamin A-deficient germfree and
conventional rats.
IV. To study the influence of the gastrointestinal flora and two of its
species on adhesion formation
around surgical anastomoses.
V. To study whether systemic antibiotics may influence adhesion
formation.
Materials and methods:
Adhesions were induced in rats by established methods and scored blindly
according to special scoring scales, one of which was developed during
the work and compared with two counterparts. Germfree and
monocontaminated rats were kept in steel isolators, the microbial status
being monitored weekly. Vitamin A deficiency was induced with special
diet and retinyl esters in liver tissue were analyzed with
high-performance liquid chromatography (HPLC). Anastomotic bursting
pressures and hydroxyproline content were measured.
Results:
Germfree rats formed less adhesions than conventional counterparts (p <
0.01). By turning germfree animals into conventional ones by establishing
an ordinary intestinal flora (ex-germfree) the propensity to form
adhesions returned (p < 0.005). The new scoring scale was not inferior at
detecting differences as compared with two other scales. Vitamin
A-deficient rats had lower anastomotic bursting pressures than vitamin A
sufficient rats (p < 0.0005) , whereas vitamin A-status had no impact on
adhesion formation but the intestinal flora-status had (p < 0.0005).
Adhesion formation Increases the more the flora status approaches the
normal state (p < 0.0001). Amoxicillin / clavulanic acid treated
conventional rats had less intestinal bacteria (p < 0.05) and formed less
adhesions (p < 0.05).
Conclusions:
The bacterial flora of the gastrointestinal canal influence adhesion
formation but is not essential for adhesions to develop. Restoration of
an ordinary flora restores adhesion forming propensity. The new scoring
scale is at least as good as scales compared at detecting differences but
has advantage in the form of being objective. Vitamin A is important for
healing of colonic anastomoses but did not affect adhesion formation
whereas the intestinal flora status did, indicating that the mechanisms
might be different. The more normal the flora gets the more normal the
adhesive response, indicating that different species of bacteria have
different adhesiogenic ability. Antibiotics lowering bacterial numbers of
the gastrointestinal flora reduce adhesions, but resistance problems may
theoretically induce growth of potent adhesiogens.The present findings
might help to explain why measures aimed at reducing fibrin do not work
on ischemic bowel and around anastomoses and warrant more research, in
which germfree animals could be valuable as a model void of the
intestinal flora influence
Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF
BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes